In Reply We agree that exercise stress testing may enhance diagnostic accuracy in HF
with preserved EF; however, there is a lack of standardized protocols and validation. Whether an
exercise stress test is superior to a standard diagnostic approach requires further research.

In contrast to peak V̇o2,
V̇e/V̇co2 slope is not used as an inclusion criterion in HF
trials. One study1 reported that the slope of
V̇e/V̇co2 is lower in patients with HF with preserved EF vs
those with HF with reduced EF, and the values from the Aldo-DHF study are in line this study. We
performed a post hoc analysis stratifying patients at a
V̇e/V̇co2 slope cutoff of 30. Spironolactone had no effect on
peak V̇o2 (P = .35 for interaction) or
E/e′ (P = .22 for interaction) when comparing subgroups above and
below a V̇e/V̇co2 slope of 30.